Patient Expectations and HRQoL After Total Joint Replacement
Patient Expectations and HRQoL After Total Joint Replacement
Osteoarthritis (OA) is a chronic degenerative joint disease and a major source of disability in the elderly. The rapid increase in the prevalence of this disease suggests that OA will have a growing impact on health care and public health systems in the near future. Total joint replacement (TJR) for the management of OA is considered to be one of the most cost-effective operations performed, with well-documented improvements in health related quality of life (HRQoL) and patient benefits, reducing pain and improving physical function.
Nowadays, the impact of patient expectations on outcomes measured by HRQoL is gaining attention. Patient expectations have generally been defined in terms of desires, needs, or requests. Other definitions differentiate between expectations and desires, such as the definition by Uhlmann et al. which describes patient expectations as anticipation that given events are likely to occur during, or as a result of, medical care, in contrast to patient desires, which reflect the patient's wishes that a given event occur. Following the expectation' definitions carried out by Haanstra et al. for this study, expectations are defined as outcome expectations: beliefs that certain actions will achieve particular outcomes. One reason for the growing interest in the relationship between expectations and HRQoL outcomes after TJR is that psychological factors in patients, such as expectations of outcome, have been found to be important contributors to the success of rehabilitation and are linked to levels of postoperative pain and functional recovery.
Some researches explain that patient expectations are strongly associated with the physician's expectations. For TJR surgery, health professionals can play important roles in positively influencing patient expectations. Providing appropriate expectations for patients helps them to develop attainable aims about their recovery and the support strategies to achieve it.
The study and measurement of patients' expectations are necessary to provide more focused clinical care, highlight areas for patient education and promote shared decision-making when several treatment options are available. With regard to treatment outcomes, patient expectations are important considerations for orthopedic surgery, particularly for elective procedures such as TJR. Moreover, preoperative patients' expectations are potentially important determinants of clinical outcomes and satisfaction. Several studies have shown that patients have multiple expectations about hip, knee, back, and shoulder arthroplasty that encompass symptom relief, improvement in physical function, and improvement in psychological well-being. In addition, OA patients with high expectations for the benefits of TJR and those who fulfilled expectations, have greater gains in HRQoL and are associated with higher satisfaction with the surgery results.
Patients' satisfaction is an important measure of outcome for a variety of reasons. Satisfaction has been related to increased patient compliance and patients who are satisfied also tend to return for follow-up care and monitoring. A number of patients are not entirely satisfied with the surgery results. This may be because the patients' satisfaction with the outcome of a TJR is a complex concept and is affected by many factors such as incomplete relief from pain, residual functional disability or unmet expectations. Some studies have shown that patients' expectations were the most important factor influencing patient satisfaction.
For any procedure and particularly for those that are widely utilized, validated tools should be used to determine the success of the procedure from the patient's perspective. The HRQoL instruments most utilized in OA had been the generic instruments Medical Outcomes Study Short Form 36 (SF-36) and Medical Outcomes Study Short Form 12 (SF-12) and the disease-specific, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
Previously indicated studies pointed out the important association of baseline expectation with surgical outcomes and satisfaction. Nevertheless, these investigations in joint replacement have inconclusive findings, in part due to the retrospective nature of the studies or failure to use multivariable models to identify the relative importance of predictors. In a recent systematic review, Haanstra et al. showed that in general there is limited evidence for an association between patient expectations and treatment outcomes in TJR and highlighted the need for more research in this area.
The objective of this study was to determine the association of baseline patient expectations with change on HRQoL outcomes measured by WOMAC and SF-12, and with satisfaction with current symptoms measured on a 4-point Likert scale, at one year post-intervention, adjusting for confounding variables such as, joint, gender, age, education, Body Mass Index (BMI), previous intervention and baseline HRQoL scores.
Background
Osteoarthritis (OA) is a chronic degenerative joint disease and a major source of disability in the elderly. The rapid increase in the prevalence of this disease suggests that OA will have a growing impact on health care and public health systems in the near future. Total joint replacement (TJR) for the management of OA is considered to be one of the most cost-effective operations performed, with well-documented improvements in health related quality of life (HRQoL) and patient benefits, reducing pain and improving physical function.
Nowadays, the impact of patient expectations on outcomes measured by HRQoL is gaining attention. Patient expectations have generally been defined in terms of desires, needs, or requests. Other definitions differentiate between expectations and desires, such as the definition by Uhlmann et al. which describes patient expectations as anticipation that given events are likely to occur during, or as a result of, medical care, in contrast to patient desires, which reflect the patient's wishes that a given event occur. Following the expectation' definitions carried out by Haanstra et al. for this study, expectations are defined as outcome expectations: beliefs that certain actions will achieve particular outcomes. One reason for the growing interest in the relationship between expectations and HRQoL outcomes after TJR is that psychological factors in patients, such as expectations of outcome, have been found to be important contributors to the success of rehabilitation and are linked to levels of postoperative pain and functional recovery.
Some researches explain that patient expectations are strongly associated with the physician's expectations. For TJR surgery, health professionals can play important roles in positively influencing patient expectations. Providing appropriate expectations for patients helps them to develop attainable aims about their recovery and the support strategies to achieve it.
The study and measurement of patients' expectations are necessary to provide more focused clinical care, highlight areas for patient education and promote shared decision-making when several treatment options are available. With regard to treatment outcomes, patient expectations are important considerations for orthopedic surgery, particularly for elective procedures such as TJR. Moreover, preoperative patients' expectations are potentially important determinants of clinical outcomes and satisfaction. Several studies have shown that patients have multiple expectations about hip, knee, back, and shoulder arthroplasty that encompass symptom relief, improvement in physical function, and improvement in psychological well-being. In addition, OA patients with high expectations for the benefits of TJR and those who fulfilled expectations, have greater gains in HRQoL and are associated with higher satisfaction with the surgery results.
Patients' satisfaction is an important measure of outcome for a variety of reasons. Satisfaction has been related to increased patient compliance and patients who are satisfied also tend to return for follow-up care and monitoring. A number of patients are not entirely satisfied with the surgery results. This may be because the patients' satisfaction with the outcome of a TJR is a complex concept and is affected by many factors such as incomplete relief from pain, residual functional disability or unmet expectations. Some studies have shown that patients' expectations were the most important factor influencing patient satisfaction.
For any procedure and particularly for those that are widely utilized, validated tools should be used to determine the success of the procedure from the patient's perspective. The HRQoL instruments most utilized in OA had been the generic instruments Medical Outcomes Study Short Form 36 (SF-36) and Medical Outcomes Study Short Form 12 (SF-12) and the disease-specific, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).
Previously indicated studies pointed out the important association of baseline expectation with surgical outcomes and satisfaction. Nevertheless, these investigations in joint replacement have inconclusive findings, in part due to the retrospective nature of the studies or failure to use multivariable models to identify the relative importance of predictors. In a recent systematic review, Haanstra et al. showed that in general there is limited evidence for an association between patient expectations and treatment outcomes in TJR and highlighted the need for more research in this area.
The objective of this study was to determine the association of baseline patient expectations with change on HRQoL outcomes measured by WOMAC and SF-12, and with satisfaction with current symptoms measured on a 4-point Likert scale, at one year post-intervention, adjusting for confounding variables such as, joint, gender, age, education, Body Mass Index (BMI), previous intervention and baseline HRQoL scores.